Diagnostic value of palpation and ultrasonography in detecting regional lymph node metastasis of eyelid sebaceous carcinoma: a decade cohort study.

Background/aims: Regional lymph node metastasis is the primary cause of disease progression in patients with eyelid sebaceous carcinoma (SC). This study aims to investigate the diagnostic accuracy of palpation and ultrasonography for detecting lymph node metastasis, as well as to identify risk factors associated with occult lymph node metastasis.

Method: This diagnostic study was conducted using a retrospective cohort of 102 patients with 120 eyelid SC tumours. All patients with eyelid SC who underwent clinical palpation and ultrasonographic imaging of regional lymph nodes at Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, between 1 January 2015 and 31 December 2024, were included.

Result: Among the 102 patients with 120 eyelid SC tumours, 33 tumours were pathologically confirmed to have lymph node metastasis. Clinical palpation demonstrated a sensitivity of 66.7% and specificity of 96.6%, while ultrasonography showed a sensitivity of 87.9% and specificity of 97.7%. The combination of ultrasonography and palpation increased the sensitivity to 93.9%, with specificity remaining high at 95.4%. In patients with negative palpation results, comparison of clinicopathological characteristics between metastatic and non-metastatic tumours revealed significant differences in American Joint Committee on Cancer (AJCC) T stage (p=0.001), tumour differentiation (p=0.046) and lymphovascular invasion (p=0.001).

Conclusions: We found that the combination of ultrasonography and palpation is an effective initial screening method, with a sensitivity of 93.9% and a specificity of 95.4%. Patients with advanced AJCC T stage, poor tumour differentiation or presence of lymphovascular invasion are more likely to present with palpation-negative lymph node metastasis.